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Employment Application
Submitter Information (Required)
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State of Wisconsin provides equal employment opportunity without regard to race, color, religion, sex, age, national origin, marital status or physical or mental disability. Consistent with the Americans With Disabilities Act, applicants may request reasonable accommodations needed to participate in the application process.

Personal Information
Application Date
First NameMiddle InitialLast Name
Social Security No.Home PhoneYour E-mail Address
Address Information
Are you 18 years of age or older?
If not, do you have a valid work permit?
Employment Desired
PositionDate you can startWage/Salary Desired
Are you now employed?
May we contact your present employer?
If no, explain
Have you ever applied with us before?
If yes, where?When?
Were you offered a Position?
Education
High School
NameLocation
Years Completed
Graduated
Subjects Studied
College
NameLocation
Years Completed
Graduated
Subjects Studied
Business, Trade, or Correspondence School
NameLocation
Years Completed
Graduaated
Subjects Studied
Other Study or Research
Job-related skills typing, etc.,

List your last four employers, starting with the most recent first.

Employment
Employer
NameAddressStart DateEnd DatePositionEnding Salary/WageReason For Leaving
Employer 1
Employer 2
Employer 3
References
NamePhone No.AddressCity, State, Zip
Reference 1
Reference 2
Reference 3
Do you have the legal right to work in the U.S.?
If hired, it will be necessary for you to promptly submit documentation of your identity and right to work in the U.S. List any days or hours when you are not available to work
Have you ever been convicted of a crime?
Note that a criminal record will not necessarily prevent employment. We will consider the nature of the event and relevant circumstances. If yes, describe the facts and circumstances and give the dates and locations.
Have you ever been discharged or asked to resign from a position?
Please provide a detailed explanation of all prior disciplinary problems/actions.
AUTHORIZATION

I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge.

I understand that if State of Wisconsin hires me, I will be required to attest to my identity and employment eligibility, and to present documents confirming my identity and employment eligibility. I understand that I cannot be hired if I cannot comply with these requirements.

I understand that any employment is conditioned on a background check. I authorize State of Wisconsin to thoroughly investigate all statements contained in my application or resume. Furthermore, I authorize my former employers and references to disclose information regarding my former employment, character, and general reputation to State of Wisconsin, without giving me prior notice of such disclosure. In addition, I release State of Wisconsin, any former employers, and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during my interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or State of Wisconsin.

I confirm that no promise regarding employment has been made to me and I understand that no such promise or commitment will be binding on State of Wisconsin unless it is in writing and signed by an officer of State of Wisconsin.

I understand that filling out this form does not indicate there is a position open and does not obligate State of Wisconsin to hire me. If hired, I agree to abide by all company work rules, policies and procedures. State of Wisconsin retains the right to revise its policies or procedures, in whole or in part, at any time.

I AGREE with the above statement